The mission of Prognosis is to explore the nexus at which healthcare policy meets healthcare practice and how one affects the other. This blog makes readers more aware of the innovations taking place in healthcare delivery, financing and technology and the types of public policies that will encourage further progress.

Healthcare In Focus is a public education initiative of the HLC, created to promote a constructive dialogue about the state and future of American healthcare.

IPAB and the Nuclear Option

November 26, 201311:55 am

With U.S. Senate Democrats exercising the so-called ‘nuclear option’ – changing Senate rules so that executive branch nominations can be approved by a simple 51-vote majority instead of the 60 votes needed to overcome a filibuster – there has been speculation about what this means for the Independent Payment Advisory Board (IPAB).

IPAB, as health policy aficionados know, is the 15-member board of political appointees created by the Affordable Care Act that has unprecedented powers over Medicare spending. To summarize IPAB in a nutshell, if Medicare spending exceeds an arbitrary level set by law, IPAB board members will offer recommendations on how to cut outlays. If Congress doesn’t achieve a supermajority in favor of an alternative approach, or doesn’t act at all, the IPAB recommendations automatically take effect.

HLC and hundreds of other patient and healthcare provider groups oppose this concept for a number of reasons, including the likelihood it would result in arbitrary reimbursement cuts that would undermine healthcare quality, accessibility and value as well as the fact it gives an unelected, unaccountable board powers constitutionally assigned to elected members of Congress.

IPAB’s controversial nature meant that it would be extremely difficult for the White House to successfully appoint board members – that is, if the Senate still had a 60-vote threshold for confirmations. Now that the ‘nuclear option’ has been invoked, some reports have said this is good news for an Administration that no longer needs Republican votes to fill the IPAB vacancies.

The fact is, though, that this is something of a non-issue.

As the Cato Institute’s Michael Cannon explained quite well in Forbes, the IPAB provisions in the Affordable Care Act make provisions for the eventuality that the President doesn’t nominate or the Senate doesn’t confirm board members. If that occurs, all of the powers granted to IPAB automatically transfer to the Secretary of Health and Human Services. If that happens, significant powers to control Medicare spending would have transferred from the legislative branch to the executive – definitely not what our Founding Fathers intended.

All this is to say that the only way to keep Medicare beneficiaries from being harmed by IPAB is to repeal it altogether, something both Democrats and Republicans in both houses have indicated they want to do.